The proposed research will implement real-time radiology decision support and study its effects on the dissemination and adoption of imaging-related comparative effectiveness research (CER) findings. The development and broad adoption of advanced imaging techniques, including computed tomography (CT), magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT) and positron emission tomography (PET) has dramatically changed the practice of medicine. However, these advances are not without costs: diagnostic imaging represents a large and growing portion of total health care spending in the U.S., and there is concern that a substantial portion of the imaging ordered and performed may be unnecessary. There is also evidence that patient preference may be responsible for at least some growth in imaging. Inappropriate imaging not only adds cost to the healthcare system, it can also cause harm via radiation exposure or over diagnosis, leading to treatments that do not improve patient outcomes. Computer physician order entry (CPOE) that includes robust decision support (DS) has great potential to improve healthcare quality and reduce cost by improving the appropriateness of tests ordered and reducing unnecessary imaging. Use of CPOE-DS to support clinical practice is one of the goals identified for "meaningful use" of electronic health record technology by CMS. The Department of Radiology at MGH was one of the first to develop and implement CPOE with real-time DS for imaging. Our Radiology Order Entry (ROE) system has been in place since 2004 and virtually all advanced imaging is now ordered using the system. ROE use has slowed the growth of imaging utilization and increased appropriateness of studies performed.1 Because ROE was developed in house, it is easily modified to incorporate an ever-evolving evidence base regarding the most appropriate use of imaging in specific clinical scenarios. Recent updates have incorporated imaging-related CER findings and expanded the tests and conditions covered. We will implement ROE at a large community hospital within Partners HealthCare System (PHS). Newton- Wellesley Hospital (NWH) is a full-service medical, surgical and specialty hospital that is fully integrated into the PHS Information Technology system but does not have DS for imaging. NWH and PHS leadership are eager to implement radiology DS, and fully support the current proposal. Working together, we will modify ROE to incorporate new imaging-related CER findings, create a new patient-focused interface and implement the system at NWH. We will conduct extensive surveys of providers and patients using the system to evaluate its acceptability, and we will study the effects of ROE implementation on imaging utilization and appropriateness. The research will contribute much needed data concerning the feasibility, acceptability and effectiveness of clinical decision support as a means to disseminate and adopt imaging-related CER findings, focusing on a large community hospital and several priority conditions. PUBLIC HEALTH RELEVANCE: The research will implement real-time clinical decision support for radiology test ordering at a large community hospital in the Boston area, and study the system's effects on the dissemination and adoption of imaging-related comparative effectiveness research (CER) findings. Clinical decision support for radiology allows relevant information concerning the potential usefulness of an imaging study to be presented to ordering physicians - and patients - in real time. The research will provide important information concerning the feasibility of using such a system at a large community hospital, and also help to understand the impact of clinical decision support on the utilization and appropriateness of imaging studies.